Provider Demographics
NPI:1902940224
Name:CHILD AND PARENT SUPPORT SERVICES
Entity Type:Organization
Organization Name:CHILD AND PARENT SUPPORT SERVICES
Other - Org Name:CENTER FOR CHILD AND FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR CLINICAL SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:919-419-3474
Mailing Address - Street 1:411 W CHAPEL HILL ST
Mailing Address - Street 2:SUITE 908
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3616
Mailing Address - Country:US
Mailing Address - Phone:919-419-3474
Mailing Address - Fax:919-419-9353
Practice Address - Street 1:411 W CHAPEL HILL ST
Practice Address - Street 2:SUITE 908
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3616
Practice Address - Country:US
Practice Address - Phone:919-419-3474
Practice Address - Fax:919-419-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300026Medicaid